美国阿拉巴马大学海尔辛克医学院Derek W. Russell团队研究了静脉推注液体对气管插管危重患者心血管衰竭的影响。2022年6月16日，《美国医学会杂志》发表了这一成果。

危重成人气管插管时低血压很常见，增加心脏骤停和死亡的风险。对接受气管插管的危重成人进行静脉输液是否可以预防严重低血压、心脏骤停或死亡，目前尚不清楚。

为了探讨快速给药对严重低血压、心脏骤停和死亡的影响，研究组进行了一项随机临床试验，纳入2019年2月1日至2021年5月24日在美国11个重症监护病房接受镇静和正压通气气管插管的1067名危重患者。最终随访日期为2021年6月21日。

将患者随机分配，其中538例接受500毫升静脉快速补液，527例不进行快速补液。主要结局是心血管衰竭（定义为在麻醉诱导至气管插管后2分钟期间新增或增加血管升压药或收缩压<65 mm Hg，或在麻醉诱导至气管插管后1小时期间心脏骤停或死亡）。次要结局是第28天前的死亡率，在出院时被审查。

在随机抽取的1067名患者中，1065名（99.8%）完成了试验并被纳入初步分析，中位年龄为62岁，42.1%为女性。快速补液组中有113名患者（21.0%）发生心血管衰竭，无补液组有96名患者（18.2%），组间差异不显著。

快速补液组中有20.6%的患者需要新增或增加血管加压素，无补液组有17.6%；两组间收缩压低于65 mm Hg的患者分别占3.9%和4.2%，心脏骤停发生率分别为1.7%和1.5%，死亡发生率分别为0.7%和0.6%。快速补液组有218名患者（40.5%）在第28天前死亡（医院出院时截止），而无补液组有223名患者（42.3%），组间差异不显著。

研究结果表明，在接受气管插管的危重成人中，静脉注射快速补液与不注射补液相比，并没有显著降低心血管衰竭的发生率。

附：英文原文

Title: Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial

Author: Derek W. Russell, Jonathan D. Casey, Kevin W. Gibbs, Shekhar Ghamande, James M. Dargin, Derek J. Vonderhaar, Aaron M. Joffe, Akram Khan, Matthew E. Prekker, Joseph M. Brewer, Simanta Dutta, Janna S. Landsperger, Heath D. White, Sarah W. Robison, Joanne M. Wozniak, Susan Stempek, Christopher R. Barnes, Olivia F. Krol, Alejandro C. Arroliga, Tasnim Lat, Sheetal Gandotra, Swati Gulati, Itay Bentov, Andrew M. Walters, Kevin M. Dischert, Stephanie Nonas, Brian E. Driver, Li Wang, Christopher J. Lindsell, Wesley H. Self, Todd W. Rice, David R. Janz, Matthew W. Semler, PREPARE II Investigators and the Pragmatic Critical Care Research Group, Stephen P. Peters, Muhammad Ali, Rita N. Bakhru, Scott Bauer, Christina R. Bellinger, Amanda M. Brown, Blair Brown, Jerri Brown, Caitlin Bumgarner, Wendy Butcher, Megan Caudle, Arjun B. Chatterjee, David J. Chodos, Gerardo Corcino, Nathan S. Cutler, Travis L. Dotson, Daniel C. Files, Jonathan L Forbes, John P. Gaillard, Katherine A. Gershner, Shannon Ginty, Kiadrick R. Hood, April Hazelwood, Katherine Hendricks, Kelly Jacobus, Jonathan T. Jaffe, Stacy Kay, Chad A. Kloefkorn, Jennifer Krall, Margo T. Lannan, Cornelia Lane, Cynthia Lanning, Jessica Lyons, William I. Mariencheck, Chad R. Marion, Matthew A. Maslonka, Sara McClintock, Nathaniel M. Meier, Matthew C. Miles, Peter J. Miller

Issue&Volume: 2022-06-16

Abstract:

Importance  Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents severe hypotension, cardiac arrest, or death remains uncertain.

Objective  To determine the effect of fluid bolus administration on the incidence of severe hypotension, cardiac arrest, and death.

Design, Setting, and Participants  This randomized clinical trial enrolled 1067 critically ill adults undergoing tracheal intubation with sedation and positive pressure ventilation at 11 intensive care units in the US between February 1, 2019, and May 24, 2021. The date of final follow-up was June 21, 2021.

Interventions  Patients were randomly assigned to receive either a 500-mL intravenous fluid bolus (n=538) or no fluid bolus (n=527).

Main Outcomes and Measures  The primary outcome was cardiovascular collapse (defined as new or increased receipt of vasopressors or a systolic blood pressure <65 mm Hg between induction of anesthesia and 2 minutes after tracheal intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after tracheal intubation). The secondary outcome was the incidence of death prior to day 28, which was censored at hospital discharge.

Results  Among 1067 patients randomized, 1065 (99.8%) completed the trial and were included in the primary analysis (median age, 62 years [IQR, 51-70 years]; 42.1% were women). Cardiovascular collapse occurred in 113 patients (21.0%) in the fluid bolus group and in 96 patients (18.2%) in the no fluid bolus group (absolute difference, 2.8% [95% CI, 2.2% to 7.7%]; P=.25). New or increased receipt of vasopressors occurred in 20.6% of patients in the fluid bolus group compared with 17.6% of patients in the no fluid bolus group, a systolic blood pressure of less than 65 mm Hg occurred in 3.9% vs 4.2%, respectively, cardiac arrest occurred in 1.7% vs 1.5%, and death occurred in 0.7% vs 0.6%. Death prior to day 28 (censored at hospital discharge) occurred in 218 patients (40.5%) in the fluid bolus group compared with 223 patients (42.3%) in the no fluid bolus group (absolute difference, 1.8% [95% CI, 7.9% to 4.3%]; P=.55).

Conclusions and Relevance  Among critically ill adults undergoing tracheal intubation, administration of an intravenous fluid bolus compared with no fluid bolus did not significantly decrease the incidence of cardiovascular collapse.

DOI: 10.1001/jama.2022.9792

Source: https://jamanetwork.com/journals/jama/fullarticle/2793545